|
RPR LAC GREATER THAN 2.6CM(T
|
Facility
|
IP
|
$1,170.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
761T1663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$1,123.68 |
| Rate for Payer: Aetna Commercial |
$901.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.99
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cigna Commercial |
$971.52
|
| Rate for Payer: First Health Commercial |
$1,111.98
|
| Rate for Payer: Humana Commercial |
$994.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,030.04
|
| Rate for Payer: Ohio Health Group HMO |
$877.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.86
|
| Rate for Payer: PHCS Commercial |
$1,123.68
|
| Rate for Payer: United Healthcare All Payer |
$1,030.04
|
|
|
RPR LAC GREATER THAN 2.6CM(T
|
Facility
|
OP
|
$1,170.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
761T1663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$1,123.68 |
| Rate for Payer: Aetna Commercial |
$901.28
|
| Rate for Payer: Anthem Medicaid |
$402.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cigna Commercial |
$971.52
|
| Rate for Payer: First Health Commercial |
$1,111.98
|
| Rate for Payer: Humana Commercial |
$994.92
|
| Rate for Payer: Humana KY Medicaid |
$402.53
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$406.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,030.04
|
| Rate for Payer: Ohio Health Group HMO |
$877.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.86
|
| Rate for Payer: PHCS Commercial |
$1,123.68
|
| Rate for Payer: United Healthcare All Payer |
$1,030.04
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
76100835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
761P0835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.23 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$990.81
|
| Rate for Payer: Anthem Medicaid |
$547.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,085.36
|
| Rate for Payer: Healthspan PPO |
$897.46
|
| Rate for Payer: Humana Medicaid |
$547.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$558.17
|
| Rate for Payer: Molina Healthcare Passport |
$547.23
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.70
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
76100835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.23 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$990.81
|
| Rate for Payer: Anthem Medicaid |
$547.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,085.36
|
| Rate for Payer: Healthspan PPO |
$897.46
|
| Rate for Payer: Humana Medicaid |
$547.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$558.17
|
| Rate for Payer: Molina Healthcare Passport |
$547.23
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.70
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
76100835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RPR OF BLEPHAROPTOSIS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
76102395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$4,680.86 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,343.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,680.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,513.68
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$3,343.47
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,012.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
RPR OF BLEPHAROPTOSIS
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
76102395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
RPR OF BLEPHAROPTOSIS
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
76102395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$682.40
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$662.14
|
| Rate for Payer: Healthspan PPO |
$605.32
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
|
|
RPR OF BLEPHAROPTOSIS(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
761P2395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$682.40
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$662.14
|
| Rate for Payer: Healthspan PPO |
$605.32
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
|
|
RPR PARASTOMAL HERNIA RDC
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
HCPCS 49621
|
| Hospital Charge Code |
76102842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.15
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
RPR PARASTOMAL HERNIA RDC
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 49621
|
| Hospital Charge Code |
76102842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Anthem Medicaid |
$624.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$765.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Humana Medicaid |
$624.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$636.53
|
| Rate for Payer: Molina Healthcare Passport |
$624.05
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$535.50
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$630.29
|
|
|
RPR PARASTOMAL HERNIA RDC
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
HCPCS 49621
|
| Hospital Charge Code |
76102842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem Medicaid |
$263.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Humana KY Medicaid |
$263.08
|
| Rate for Payer: Kentucky WC Medicaid |
$265.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.15
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
RPR PARASTOMAL HRNA NCR/STRN
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 49622
|
| Hospital Charge Code |
76102843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.85
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
RPR PARASTOMAL HRNA NCR/STRN
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 49622
|
| Hospital Charge Code |
76102843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Anthem Medicaid |
$770.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$935.00
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Humana Medicaid |
$770.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$785.98
|
| Rate for Payer: Molina Healthcare Passport |
$770.57
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.50
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$778.28
|
|
|
RPR PARASTOMAL HRNA NCR/STRN
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 49622
|
| Hospital Charge Code |
76102843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem Medicaid |
$321.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Humana KY Medicaid |
$321.55
|
| Rate for Payer: Kentucky WC Medicaid |
$324.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.85
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
RPR QUAL
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna Commercial |
$3.32
|
| Rate for Payer: First Health Commercial |
$3.80
|
| Rate for Payer: Humana Commercial |
$3.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.24
|
| Rate for Payer: PHCS Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Payer |
$3.52
|
|
|
RPR QUAL
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$5.98 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Anthem Medicaid |
$1.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna Commercial |
$3.32
|
| Rate for Payer: First Health Commercial |
$3.80
|
| Rate for Payer: Humana Commercial |
$3.40
|
| Rate for Payer: Humana KY Medicaid |
$1.38
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.24
|
| Rate for Payer: PHCS Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Payer |
$3.52
|
|
|
RPR QUAL
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
RPR QUAL
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
RPR QUANT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
30001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Humana Medicare Advantage |
$4.40
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.64
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
RPR QUANT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
30001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.64
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
RPR REM HERNIA INIT REDUCE
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
76102017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$820.31 |
| Rate for Payer: Aetna Commercial |
$820.31
|
| Rate for Payer: Anthem Medicaid |
$351.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$764.71
|
| Rate for Payer: Healthspan PPO |
$691.78
|
| Rate for Payer: Humana Medicaid |
$351.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$727.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.77
|
| Rate for Payer: Molina Healthcare Passport |
$351.74
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.26
|
|
|
RPR REM HERNIA INIT REDUCE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
76102017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
RPR REM HERNIA INIT REDUCE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
76102017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
